Long Term Care Providers
A Client Engagement About Redesigning Medicaid Reimbursement For Nursing Home Care
In the Summer of 2005, Sellers Dorsey (formerly Sellers Feinberg) was hired by a group of three long term care providers that offer specialized nursing care for non-elderly adults with physical disabilities. The highly specialized nature of the care provided in these facilities had been recognized by the State through a separate provider class accompanied with a higher rate of reimbursement. Almost all of the residents of these facilities receive therapeutic care and are aided by the use of special adaptive technology, and almost all have their care paid for by Medicaid.
Beginning in late 2005, the Pennsylvania Department of Public Welfare embarked on an effort to reform Medicaid reimbursement for all nursing home providers. Initially, the Department signaled their intent to repeal the separate provider class for the special rehabilitation facilities, a change which would have seriously impacted these facilities Medicaid reimbursement and subsequently their ability to care for residents. Additionally, Sellers Dorsey identified concerns or questions raised by the Department as to the nature of care being provided in these facilities. In response to the Department’s initial proposals to Medicaid reimbursement, Sellers Dorsey proposed and implemented a strategy to manage a potentially adverse outcome.
Sellers Dorsey closely worked with the providers to outreach to Pennsylvania officials and successfully demonstrated the need for their special provider class and higher Medicaid reimbursement. Furthermore, Sellers Dorsey analyzed the State’s proposals at each step in the process to determine the financial impact to the providers. Within a few months, the Department indicated they favored the retention of the separate reimbursement peer group for these facilities, and abandoned a number of other proposals that would have led to a serious reduction in their reimbursement. Working with Sellers Dorsey, the three long term care providers were able to play a significant role in the outcome of the Department’s final proposal and favorably resolved each of their unique challenges to ensuring sufficient funding from the state. Sellers Dorsey is pleased to have worked with the Special Rehabilitation Facilities and provided valuable guidance during the intensive process.